Sarcopenia is recognized as a significant comorbidity in patients with Cardiovascular-Kidney-Metabolic (CKM) Syndrome, yet validated prediction models for this population remain lacking. This study aimed to develop and validate a nomogram for predicting sarcopenia risk in Chinese patients with CKM syndrome.

Data were derived from the China Health and Retirement Longitudinal Study (CHARLS) and an independent hospital dataset. The CHARLS 2015 dataset was split into a training set and an internal validation set; the CHARLS 2011 dataset served as the external validation set; and inpatients from Guangdong Provincial Hospital of Chinese Medicine constituted the hospital validation set. Sarcopenia was diagnosed according to the 2025 Asian Working Group for Sarcopenia criteria. Least absolute shrinkage and selection operator (LASSO) regression combined with multivariable logistic regression was used for predictor selection and model development. Model performance was evaluated by discrimination, calibration, and decision curve analysis (DCA).

Nine predictors were identified: age, smoking status, high-density lipoprotein cholesterol, triglycerides, uric acid, C-reactive protein, hemoglobin, chronic obstructive pulmonary disease, and chronic liver disease. The model achieved area under the curve values of 0.817, 0.808, 0.800, and 0.834 in the training, internal validation, external validation, and hospital validation sets, respectively. Calibration was satisfactory in development cohorts (p > 0.05), with some calibration drift in external populations. DCA confirmed clinical utility across all datasets.

The developed nomogram incorporating nine accessible predictors demonstrated robust discrimination and clinical applicability for sarcopenia risk assessment in Chinese CKM patients, supporting its use in early screening and individualized intervention.

Deep vein thrombosis (DVT) is a common postoperative complication in orthopedic surgery and may result in life-threatening events such as pulmonary thromboembolism (PTE). However, evidence on the optimal prophylactic strategy for DVT following foot and ankle surgery remains limited. This study aimed to assess the effect of pharmacologic thromboprophylaxis in patients undergoing foot and ankle surgery with postoperative immobilization.

A retrospective review was conducted of 451 patients who underwent foot and ankle surgery followed by short-leg splint immobilization with restricted ankle motion for more than 2 weeks between April 2022 and February 2024. All patients underwent routine screening duplex ultrasonography at 2 weeks postoperatively, regardless of symptom status. Patients were categorized into 3 groups based on postoperative pharmacologic thromboprophylaxis: no anticoagulation, aspirin (Aspirin Protect, Bayer AG) 100 mg once daily for 14 days, and enoxaparin (a low-molecular-weight heparin; Clexane, Sanofi) 40 mg once daily during hospitalization followed by aspirin after discharge to complete a total of 14 days. The incidence of DVT was compared using the chi-square test, and multivariate logistic regression analysis was performed to adjust for potential confounders.

Of the 451 patients, 73 patients (16.2%) developed DVT. The incidence of DVT was comparable among the 3 groups, with no statistically significant differences observed (no-anticoagulation group: 24 of 147 [16.3%]; aspirin group: 25 of 145 [17.2%]; enoxaparin group: 24 of 159 [15.1%]; p = 0.34). Most DVTs were asymptomatic (66 / 73, 90.4%) and confined to the distal calf veins (70 / 73, 95.9%), while proximal DVT was rare (3 / 73, 4.1%), occurring in 1 patient in each group. Multivariate logistic regression analysis demonstrated no significant association between pharmacologic thromboprophylaxis and postoperative DVT after adjustment for confounding variables.

In this retrospective cohort, pharmacologic thromboprophylaxis with enoxaparin or aspirin was not associated with a reduced incidence of postoperative DVT following foot and ankle surgery with immobilization. These findings should be interpreted cautiously given the observational design and short duration of prophylaxis. A uniform anticoagulation strategy may not be appropriate for all patients.

In the face of escalating medical complexity, the development of simple strategies that allow the optimization of resources becomes more urgent than ever. This is particularly evident in cardiovascular diseases (CVD), where despite successful risk stratification and mitigation strategies, elevated mortality rates persist among socioeconomically disadvantaged groups. Efforts to prevent CVD events rely on early identification of at-risk individuals and timely implementation of risk-mitigating measures. Persistent challenges in health systems to identify and intervene with high-risk patients underline the growing importance of implementation science. Operating in the real-world context, this field allows to bridge the gap between identifying at-risk individuals and implementing tailored therapeutic strategies, facilitating the clinical assimilation of diagnostic and therapeutic advancements. RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework was applied to structure and evaluate this implementation process.

The CARDIOGAP + project emerges as a prospective solution to this challenge. By focusing on the industrial and manufacturing workforce, it seeks to achieve the early identification of high and very high-risk individuals through data routinely collected in Occupational Medicine (OM) appointments, which occur biennially (or annually for individuals aged 50 or over). Patients will be risk stratified according to the ESC guidelines using the data collected on the OM appointments, allowing a systematic and prompt recognition of individuals at elevated cardiovascular (CV) risk. The identified patients will be referred to a CV risk hospital consultation, where therapeutic interventions fostering adherence will be implemented. After the first hospital appointment, patients will be followed up to 1 year. As a pilot implementation study, sample size was determined by feasibility and precision considerations rather than by a formal power calculation for the exploratory 12-month risk-factor outcomes.

This study was developed with reference to the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) recommendations, adapted for a non-randomized implementation study, and in compliance with the Declaration of Helsinki and Good Pharmacoepidemiology Practice (GPP). Reporting of study results will follow the STROBE guidelines, ensuring ethical conduct and data integrity. Written informed consent will be obtained from all participants or their legal representatives. Confidentiality is safeguarded through de-identification and secure data storage. Results may be published or shared in public databases, following Novartis and ICMJE standards.

In paediatric cardiac intensive care units (PCICUs), shift-based safety checks are critical to ensuring equipment readiness during time-sensitive emergencies. Reliance on paper-based checklists resulted in variable compliance and limited accountability. A critical incident involving a non-functional defibrillator during a paediatric cardiac arrest was identified as a system-level failure rather than individual staff error, exposing the risk of unpreparedness.

To improve and sustain compliance with shift safety checks through a QR code-based digital checklist system with automated reminders and escalation, enhancing patient safety and staff readiness.

Following root cause analysis and guided by a Just Culture approach, this quality improvement project, conducted in a tertiary PCICU in the United Arab Emirates, used Kotter's eight-step change model and Plan-Do-Check-Act (PDCA) cycles. A multidisciplinary team developed a mobile-accessible digital checklist. QR codes were placed on critical equipment and clinical areas. Staff scanned the QR code at the item location and completed checks in real time. Microsoft Power Automate sent reminders to the team leader after 2 h, with escalation to the unit manager after 3 h if checks remained incomplete. The intervention was piloted over 1 month and expanded unit wide.

Compliance with shift safety checks improved from a baseline of 82% to 90% at 3 months. After resolution of technical issues and reinforcement of staff education, compliance reached and was sustained at 100% by 6 months. Staff satisfaction increased from 68% at baseline to 91% at 3 months and 96.3% at 6 months. Documentation became fully auditable, equipment readiness at the start of each shift markedly improved, and no further critical equipment failures were reported during emergency events.

Sustained improvement was achieved by combining accessible digital technology with structured change management, iterative PDCA cycles and a Just Culture approach, supporting durable transformation of shift safety checks in a high-acuity PCICU.

QR code-based digital checklists with automated reminders and escalation offer a low-cost, scalable approach for critical care units to strengthen equipment readiness, enable real-time documentation at the point of checking, improve auditability and reduce reliance on paper and time away from patients.

We utilized an Alzheimer's disease (AD) polygenic risk score (PRS) to discover associations with novel rare variants (RVs).

PRSs for European ancestry (EA) participants of the Alzheimer's Disease Sequencing Project were calculated using summary statistics from a large genome-wide association study. Participants were classified into high (n = 5738) and low (n = 5324) PRS groups based on the median PRS and on the lower and upper 35% of the PRS distribution.

Risk variants were disproportionately enriched in the low-PRS group, while protective ones were disproportionately enriched in the high-PRS group. Genome-wide significant (GWS) associations for increased AD risk were identified with RVs spanning a 3.5-Mb region on chromosome 14. GWS protective variants in ALDH9A1, BICC1, and PAN3 were identified in the upper 35% PRS group.

Our findings provide unique opportunities to study RVs whose effects are opposite to the risk conferred by the genetic background.

Arrhythmias, including atrial fibrillation and ventricular tachycardia, are associated with substantial morbidity and healthcare utilization in older adults. Ambulatory cardiac monitoring (ACM) is used to evaluate suspected or known arrhythmias; however, monitoring modalities vary in duration, diagnostic yield, and cost. We evaluated differences in total cost of care across major ACM modalities using real-world Medicare claims data.

We conducted a retrospective cohort analysis using the Merative MarketScan Medicare Claims Database to estimate per patient per month (PPPM) costs in the 12 months following initiation of one of four ACM modalities among Medicare beneficiaries newly monitored between 2016 and 2024. The analytic cohort included 132,082 beneficiaries: Holter (n = 70,799), long-term continuous monitoring (LTCM, n = 25,294), mobile cardiac telemetry (MCT, n = 20,085), and external ambulatory event monitoring (AEM, n = 15,904). Entropy balancing was applied to align baseline covariates. Weighted mean PPPM costs and Tukey-adjusted pairwise cost differences were estimated using weighted regression models.

Holter monitors accounted for the largest share of index monitoring, while LTCM utilization increased substantially over the study period. Weighted PPPM costs were lowest for LTCM ($2,678), followed by AEM ($2,721), Holter ($2,873), and MCT ($3,034) (overall p < .001). In pairwise comparisons, Holter and MCT had significantly higher weighted PPPM costs than LTCM, with absolute differences of $196 (p = .002) and $357 (p < .001), respectively. AEM had numerically higher weighted PPPM costs than LTCM ($44; p = .938).

Among Medicare beneficiaries, LTCM was associated with lower weighted 12-month total costs of care compared with Holter and MCT.

Cardiac distress is common, yet minimal support is available for nurse assessment of patients. We translated the Cardiac Distress Inventory (CDI) into Thai (CDI-Thai) and evaluated its psychometric properties. This was a cross-sectional study of 250 adults who experienced an acute cardiac event in the past year in southern Thailand. The CDI was translated into Thai using forward-backward translation and expert review. The CDI-Thai achieved translation equivalence to the original version. An eight-factor structure was confirmed by factor analysis, with excellent fit. The CDI-Thai was shown to be culturally relevant and psychometrically robust as a measure of cardiac distress.

Apolipoprotein B (ApoB) is widely recognized as a biomarker significantly associated with cardiovascular risk. However, the correlation between ApoB and the severity of coronary artery anatomical stenosis (Gensini score) in individuals aged 45 and above has not been fully studied.

A cross-sectional retrospective analysis was conducted, involving 818 patients who underwent coronary angiography. Fasting blood samples were collected to measure lipid parameters, including ApoB. The severity of coronary artery stenosis was assessed using the Gensini score, and patients were divided into two groups based on the median cut-off (<36 vs. ≥ 36). A multivariate regression model was used to evaluate the association between ApoB and the severity of stenosis after adjusting for potential confounding factors.

Compared to the mild stenosis group (Gensini score < 36), the moderate-to-severe stenosis group (score ≥ 36) had significantly higher levels of ApoB (1.0 ± 0.3 vs. 0.9 ± 0.3 g/L) and LDL-c (p < 0.05), while HDL-c and ApoA levels were lower (p < 0.001). Multivariate regression analysis indicated that ApoB was independently associated with moderate-to-severe coronary stenosis (β = 46.1, 95% CI: 31.3-61.0 p < 0.001). Sensitivity analysis using continuous Gensini score confirmed the association (β = 22.57, 95% CI: 13.67-31.47, p < 0.0001). Dose-response analysis revealed that higher ApoB tertiles were associated with progressively higher Gensini scores (P for trend = 0.001). Stratified analysis revealed a consistent positive correlation between ApoB and Gensini scores across all clinical subgroups (all p < 0.05), with no significant interactions detected (all P for interaction > 0.05).

ApoB levels are significantly positively correlated with the severity of coronary artery stenosis in the population aged ≥ 45 years, indicating its potential clinical application value in evaluation.

Postoperative atrial fibrillation (POAF) is well recognized after cardiac surgery; however, its incidence and clinical course following non-cardiac surgery (NCS) remain unclear.

To evaluate the association between POAF after NCS, patient co-morbidities, and type of surgery.

In this retrospective cohort study, patients who underwent NCS at a private hospital network between 2016 and 2023 were included. Patients with a history of atrial fibrillation (AF) were excluded. Patients who developed POAF within 24-48 hours were compared with those who did not. To address baseline differences, propensity score matching (1:10) and inverse probability weighting combined with Firth's penalized logistic regression were applied. Odds ratios with 95% confidence intervals were calculated.

POAF developed in 174 patients within 24-48 hours postoperatively, compared with 391,329 controls. Older age, ischemic heart disease, diabetes, and prior stroke were associated with increased odds of POAF, although significance diminished after multivariable adjustment. Weighted regression confirmed these findings with narrower confidence intervals. Higher POAF risk was observed after laparoscopic pancreatectomy, hepatectomy, rectopexy, synovectomy, and gastrectomy. Total knee replacement was the most common procedure among POAF cases, representing 22% of cases and a fourfold increased risk.

Advanced age and cardiovascular co-morbidities were associated with increased POAF risk after NCS, although attenuated after adjustment. Consistent findings across statistical models support the robustness of the results. Targeted monitoring in high-risk patients may improve postoperative outcomes.

Electrocardiogram (ECG) may detect atrial fibrillation (AF), but the true rate of ECG performance is unknown.

To explore the performance rate of ECG testing in patient populations at high risk for AF in a real-world cohort and to explore the incidence of newly diagnosed AF.

This retrospective observational cohort study included de-identified data of members of Maccabi Health Services older than 65 years, excluding patients with prior AF and other cardiac diseases. Patients were followed between 1 January 2016 and 30 September 2020. The number of ECGs performed in an outpatient setting for each patient was reported.

In total, 211,515 patients (59.8% female) were included. The mean age was 70.3 ± 6.6 years, with a mean CHA2DS2-VASc score of 2.6 ± 1.0. During the study period, over half of the patients (n=112,340; 53.1%) did not undergo any ECG tests, 51,644 patients (24.4%) had one ECG, 24,914 patients (11.8%) had two, while 22,617 patients (10.7%) had more than three. Of the patients referred for an ECG, 67,433 (81.1%) underwent ECG testing within 2 months following the referral. The median time from ECG referral to ECG testing was 5 days.

Most patients older than 65 years had no ECG tests within a 5-year period. However, when referred to an ECG test, most patients complied within a median of 5 days.